Over the course of the last decade, end-of-life care has witnessed two defining trends, according to a new report: For one, ill patients have spent less time in the hospital and more time in hospice. Secondly, for those hospitalized, the intensity of their care has increased significantly.
A new report from the Dartmouth Atlas Project, comparing Medicare patient data between 2003 and 2007, reveals that chronically ill patients are now less likely to die in a hospital, and there is a greater chance they would receive hospice care. Yet a hospital stay resulted in more aggressive care, with patients spending more time in intensive care units and receiving visits from medical specialists.
One constant that remained between 2003 and 2007 was the wide variation in regional practices, which affect the course of end-of-life care for a given patient. A second constant was the high cost, comparatively, of end-of-life care and, unequivocally, of care for patients with chronic illness.
“In addition to its effects on patients’ quality of life, unnecessarily aggressive care carries a high financial cost. About one-fourth of all Medicare spending goes to pay for the care of patients in their last year of life, and much of the growth in Medicare spending is the result of the high cost of treating chronic disease,” said the study’s lead author Dr. David Goodman in a statement.
Tracking the Changes
Below, we take a closer look at the areas that have changed and invite your opinion in a series of polls related to each segment of study.
Hospital Mortality Rates
The chances that a chronically ill Medicare patient dies in a hospital have decreased. In 2007, 28 percent of this population died in a hospital, compared to 32 percent in 2003. According to the date, 272 out of 306 regions across the U.S. saw a decrease.
Days in Hospital in Final Six Months of Life
Again, the numbers fell in overall hospital utilization, in this case during a chronically ill patient’s last six months of life. From 2007 to 2003, the national rate dropped from 11.3 days to 10.9 days. Some regions saw significant decreases, including Corpus Christi, Texas (-4 days), and Newark, New Jersey (-3.5 days). Others, like San Mateo, California, saw a sizeable increase (+2.6 days).
Intensive Care Usage
Despite the overall drop in hospital days during a patient’s end-of-life period, the amount of time a patient spent in an intensive care unit increased between 2003 and 2007, from an average of 3.5 days to an average of 3.8 days. Once again, usage varied wildly among regions.
Hospice Days During Last Six Months
Perhaps the most substantial change between 2003 and 2007, the number of days one spent in hospice care increased sharply, jumping nearly 48 percent over the short time span. Hospice usage in the final six months of life shot up from 12.4 days in 2003 to 18.3 days in 2007. Ogden, Utah, took the title of top-hospice region, where a patient spent an average of 39.5 days in hospice.
Multiple Doctors in Last Six Months of Life
Another significant figure to come out of the Dartmouth Atlas report is the percentage of patients who saw 10 or more doctors in the final six months of their life. This figure jumped from 30.8 percent in 2003 to 36.1 percent in 2007.
A quote from the researchers sums up the importance of the new research: “Patients can look to these data to get a sense of where care is likely to be more or less aggressive. Providers can look to these data for insights into the likely magnitude of savings they can achieve through improved care of chronic illness that allows patients to remain safely out of the hospital.”
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Cl's who are end stage are still going into the hosp and into ICU.
It is rare that hospice is suggested and when hospice is approached most families are upset and concerned and view it as a negative.
We need to do con't and massive education. Hospice has a bad rep.
Hospice providers need more education and need to be less aggressive when dealing w families.
Over the past few years I have had hospice for 6 fam mbrs who were terminal. I had to intervene and tell providers to back off.
I believe because I was am advocate for my fam mbrs and was always there - hospice worked for us. Most families do not have my skills or training but should also not need them.
Educate! Educate! and Educate!
Thank you for listening
jean
Many studies and anecdotal evidence show the value of hospice on quality of life and, in fact, duration of life. Glad to hear that your personal interventions paid off, Jean.
It is a discussion beyond hospice, as much as I belive in hospice and have had personal experience. People in their 80's talk about dying, even want to die. No one hears them, nor do they have a way to pursue this option in our country. They do not know they can create a legal document that will disallow treatment.
Being provided an opportunity to allow each person's desires to be known, and documented, is key to the creation of a logical end of life process within our system.